State moves to limit ER visits

The Washington State Health Care Authority is working with the Washington State Hospital Association and physicians on a legislative mandate to reduce non-emergency use of hospital emergency departments as well as over-utilization of emergency services beginning July 1.

The new plan — included in the Supplemental Budget passed on April 11 by the Legislature — replaces earlier state proposals that would have limited the annual number of non-emergency visits by a client to the emergency department and to stop reimbursing hospitals and physicians for treatments and services that are not medically necessary in the setting of an emergency department.

Instead, the new plan follows a collaborative effort this spring with the American College of Emergency Physicians, the Washington State Medical Society and the hospital association to agree on ways to better manage emergency department services and prevent over-utilization.

Included will be commitments by hospitals across the state to implement those changes, including electronic health information exchanges on high emergency department utilizers, especially patients with drug- or painkiller-seeking behaviors.

Doctors and hospitals are  supporting the new guidelines process.

“Good communication between hospitals, doctors, patients and Medicaid is needed to make this new plan succeed,” said Jeff Thompson, M.D., chief medical officer of the Health Care Authority, which includes the Medicaid program.

The legislative budget proviso endorsing the new emergency department policy calls for $31 million in savings (includes both state and federal matching funds) as a result of the changes.

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